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Multiple MyelomaPhase 2NCT00427765

Busulfan Plus Melphalan Conditioning Regimen for Lymphoid Malignancies or Multiple Myeloma

A Phase 2 study testing Busulfan and Melphalan in people with Multiple Myeloma and Lymphoma, run by M.D. Anderson Cancer Center at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Primary Objectives: 1. To determine the efficacy of administering multiple doses of intravenous (i.v.) busulfan at a dose of 130 mg/m2, to yield a systemic plasma drug exposure represented by a daily area under the plasma concentration versus time curve (AUC) of approximately 5,000 mMol-min for 4 days, followed by… Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Multiple Myeloma, Lymphoma
What is being tested?
Busulfan and Melphalan
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
168 participants
Where
1 siteUnited States
Study dates
Dec 2004to Nov 2010
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients with lymphoid malignancies, including Hodgkin's and non-Hodgkin's lymphoma (primary refractory or recurrent), or multiple myeloma (beyond first complete remission or unresponsive to therapy. Complete remission for multiple myeloma defined by absence of detectable paraprotein in serum and/or urine by immunoelectrophoresis or immunofixation, and < 5% plasma cells in the bone marrow), not qualifying for treatment protocols of higher priority.
  • Age 18 to 65 years of age.
  • Adequate renal function as defined by estimated serum creatinine clearance > 50 ml/min and serum creatinine < 1.8 mg/dL.
  • Adequate hepatic function, as defined by serum glutamic pyruvic transaminase (SGPT) < 3 * upper limit of normal; serum bilirubin and alkaline phosphatase < 2 * upper limit of normal, or considered not clinically significant.
  • Adequate pulmonary function with Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and Capacity of the Lung for Carbon Monoxide (DLCO)> 50%. Exceptions may be allowed for patients with pulmonary involvement after discussing with principal investigator (PI).
  • Adequate cardiac function with left ventricular ejection fraction >/= 40%. No uncontrolled arrhythmias or symptomatic cardiac disease.
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  • Zubrod performance score < 2.
  • Patients receiving an allogeneic transplant must have an HLA matched, or one A, B, or DR mismatched related donor. Unrelated donor must be matched at A, B, and DR (defined as A, B serologic matched and DRB1 molecular matched). Donor must be willing to donate peripheral blood or bone marrow progenitor cells.
  • Patient and donor should be willing to participate in the study by providing written consent.
  • Female patient must not be pregnant and have negative pregnancy.

Who cannot join

  • Patients with unresolved grade >/= 3 non-hematologic toxicity from previous therapy. Patients with grade 2 toxicity will be eligible at the discretion of the PI.
  • Patients with active Central Nervous System (CNS) disease.
  • Evidence of acute or chronic active hepatitis or cirrhosis. If positive hepatitis serology, discuss with Study Chairman and consider liver biopsy.
  • Uncontrolled infection, including Human immunodeficiency virus (HIV) or Human T-lymphotropic virus Type I (HTLV-1) infection.
  • Patients who have had a previous autologous or allogeneic stem cell transplant during the past year.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • UT MD Anderson Cancer Center

    Houston, Texas, 77030

Other trials in United States

About this study

Official title: A Phase II Study of High-Dose Intravenous Busulfan Plus Melphalan With Allogeneic or Autologous Marrow or Peripheral Blood Progenitor Cell Transplantation for Lymphoid Malignancies or Multiple Myeloma

Primary Objectives:

  1. To determine the efficacy of administering multiple doses of intravenous (i.v.) busulfan at a dose of 130 mg/m2, to yield a systemic plasma drug exposure represented by a daily area under the plasma concentration versus time curve (AUC) of approximately 5,000 mMol-min for 4 days, followed by i.v. melphalan at a dose of 70 mg/m2 for 2 days in adult patients receiving autologous or allogeneic transplantation for lymphoid malignancies or myeloma.
  2. To describe the plasma pharmacokinetic (PK) profiles of busulfan and melphalan in this regimen.
  3. To determine the disease-free and overall survival of patients receiving this preparative regimen.
  4. To determine the treatment-related morbidity and mortality of this combination of drugs.
Read the detailed description

Busulfan and melphalan are both traditional alkylating agents that are designed to interfere with the production of cancer cells at the DNA (deoxyribonucleic acid) and RNA (ribonucleic acid) level.

Before you can start treatment on this study, you will have what are called "screening tests". These tests will help the doctor decide if you are eligible to take part in the study. You will have a complete physical exam, including routine blood (2-3 teaspoons) and urine tests. Patients will have a chest x-ray, heart scan, lung function test, and a bone marrow biopsy. Women who are able to have children must have a negative blood pregnancy test.

If you are found to be eligible to take part in this study, you will be able to start receiving chemotherapy treatment with busulfan and melphalan. Participants who agree to the optional blood draws described above will at first receive a therapeutic "trial dose" of busulfan by vein to test the blood levels over time. This therapeutic trial dose of busulfan is about 25% (1 fourth) of the full therapeutic dose of the drug. This information will be used to decide what the future high-dose busulfan treatments you receive will be. If you do not agree to the optional blood draw, you will receive a fixed amount of high-dose busulfan from the start.

On the 1st day of hospitalization, you will receive fluids by vein through a central venous catheter. If you choose the optional busulfan dose for pharmacokinetic-based busulfan dosing, you will receive the optional busulfan dose 9 days before stem cell infusion (Day 1), followed by a rest day on Day 2. If you choose to receive a fixed dose of busulfan, busulfan will be injected through a central venous catheter over 3 hours, once a day, for the next 4 days (Days 3-6, ending 3 days before the stem cell infusion day).

Patients receiving pharmacokinetic-based dosing of busulfan will also continue to receive busulfan on Days 3-6. This will be followed by melphalan for all patients, given through your central venous catheter over 30 minutes, once a day, for 2 days, on days 8 and 9. Your stem cell infusion day will be on Day 10 of treatment.

Patients receiving 5 out of 6 antigen matched-related allogeneic stem cell transplants or unrelated allogeneic stem cell transplants will also receive antithymocyte globulin (ATG), by vein, on Days 7-9, up to one day before the stem cell infusion. This is given to decrease the risk of GVHD and graft rejection in mismatched transplants.

On Day 10, healthy blood stem cells or bone marrow from the donor will be given through the central catheter. This is your transplant date. You will also receive several other medications to help the treatment work and to help prevent infections while your immune system is weak. Tacrolimus and methotrexate will be given to decrease the risk of graft-versus-host-disease (GVHD). GVHD occurs when the donor's immune cells fight the patient's body. The tacrolimus will be started on the day before the transplant and will continue for up to six months. Tacrolimus is given by vein at first and then by mouth when you are able to eat. Methotrexate is given by vein on Days 11, 13, 16, and possibly on Day 21, up to 11 days after the transplant.

Please note that the treatment dates listed above were used to help explain your general treatment plan. By standard medical convention, the day of stem cell infusion is always listed as day zero. Therefore, the days listed above are different from the treatment plan described in the protocol and abstract.

Sulfamethoxazole (Bactrim) or pentamidine will be given to fight bacteria. Bactrim is given by mouth when the counts are good. Pentamidine is given by vein when the counts are low. Acyclovir will be given at first by vein and then Valtrex (valacyclovir) will be given by pill to decrease the risk of viral infections. Granulocyte colony-stimulating factor (G-CSF) will be given to help the new bone marrow grow. It is given as an injection under the skin after the transplant. It will continue until the white blood cells reach an acceptable level. Overall, some of these drugs will be given for as long as 6 months or possibly longer. Other medications may be necessary. If you are allergic to some of these drugs, changes will be made.

You will be in the hospital for about 3-4 weeks. You will have checkups every day until discharged from the hospital. You will then be seen in the outpatient clinic at least 3 times a week until your blood counts improve. You will be seen by your doctor at least every week until 100 days after the bone marrow transplant. You must stay in Houston during this time. After 100 days, you will return to the clinic according to your individual physician's recommendations.

Some patients may need to receive spinal taps with instillation of chemotherapy several times over the year after transplantation. This is only for patients with a previous clinical history of leukemic involvement of the brain or high risk of developing leukemia relapse in the brain. The spinal tap is performed in the clinic. You are given local anesthetic at the lower back site, a small needle is inserted in the space between 2 spinal bones, a small amount of fluid that bathes the brain (cerebrospinal fluid) is removed for testing, and a small amount of chemotherapy is given.

Bone marrow samples will be taken at about 1 month and 3 months after the transplant. You will also have a lung function test at 3 months after the transplant.

This is an investigational study. The FDA has approved all of the drugs used in this study for use in stem cell transplantation. Up to 168 patients will take part in this study. All will be enrolled at M. D. Anderson.

Being tested
Busulfan, Melphalan
Keywords
Multiple Myeloma, Hodgkin's Disease, Non-Hodgkin's Lymphoma, Leukemia, Lymphoma, Busulfan, Melphalan, Autologous bone marrow, BMT, Peripheral blood stem cell transplant, PBSCT
Medical subject headings
Multiple Myeloma, Lymphoma, Hodgkin Disease, Lymphoma, Non-Hodgkin, Leukemia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • BusulfanDrug

    Also called Busulfex

    Test Dose = 32 mg/m^2 IV for 1 Day; 130 mg/m^2 IV for 4 Days

  • MelphalanDrug

    70 mg/m^2 IV for 2 Days

Study groups in NCT00427765
Study groupRoleWhat they receive
Busulfan + MelphalanExperimentalBusulfan 32 mg/m^2 intravenous (IV) for 1 Day then 130 mg/m^2 IV for 4 Days; and Melphalan 70 mg/m^2 IV for 2 Days
Receives: Drug: Busulfan; Drug: Melphalan

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Average Overall Survival Time

    Average number of years for survival post transplant where overall survival time is measured from date of transplant to disease progression or death for any reason.

    Measured: Baseline(transplantation) to disease progression or death for any reason, up to 6 years.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Jan 2007 (estimated)
  2. Study startDec 2004
  3. Primary completionNov 2010
  4. Study completionNov 2010

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
168 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00427765
Sponsor's protocol ID
2004-0190
Status last verified
Dec 2011
First submitted
25 Jan 2007
Last updated
19 Jan 2012
Data monitoring committee
No

Publications

  • Nieto Y, Gruschkus S, Valdez BC, Jones RB, Anderlini P, Hosing C, Popat U, Qazilbash M, Kebriaei P, Alousi A, Saini N, Srour S, Rezvani K, Ramdial J, Barnett M, Gulbis A, Shigle TL, Ahmed S, Iyer S, Lee H, Nair R, Parmar S, Steiner R, Dabaja B, Pinnix C, Gunther J, Cuglievan B, Mahadeo K, Khazal S, Chuang H, Champlin R, Shpall EJ, Andersson BS. Improved outcomes of high-risk relapsed Hodgkin lymphoma patients after high-dose chemotherapy: a 15-year analysis. Haematologica. 2022 Apr 1;107(4):899-908. doi: 10.3324/haematol.2021.278311.

    PubMed 33951890

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Busulfan and Melphalan in people with Multiple Myeloma and Lymphoma, run by M.D. Anderson Cancer Center at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Jan 2012. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 19 Jan 2012). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Average Overall Survival Time (time frame: Baseline(transplantation) to disease progression or death for any reason, up to 6 years.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00427765, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Jan 2012.

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Clinical Trial NCT00427765 | AzTrials